Treatment

There is currently no definitive cure for Meniere disease. Treatment is directed toward symptomatic management and prevention of recurrence. Interventional therapy or surgery is reserved for patients with intractable symptoms that significantly hinder their quality of life.

• Consider short-term symptomatic pharmacotherapy with vestibular suppressants (e.g, first-generation antihistamines, benzodiazepines, antiemetics).

• Consider movement restriction.

Vestibular suppressants are the treatment of choice for an acute vertigo attack in Meniere disease.

Chronic use of vestibular suppressants is contraindicated because of their potential to inhibit central compensation, which could elicit gait and postural instability.

• Lifestyle modifications

  • Stress reduction

  • Low-sodium diet (1500–2300 mg per day)

  • Identification and avoidance of dietary and environmental triggers (e.g., caffeine, alcohol, nicotine, and stress).

• Other:

  • Allergen testing, avoidance, and treatment

  • Patients should be educated about avoiding known triggers and the natural course of the disease, including recurrence and worsening of SNHL with each attack.

Patients with frequently recurring episodes of Meniere disease may be considered for chronic pharmacotherapy.

• Diuretics

  • Thiazide diuretics (with or without a potassium-sparing diuretic) are commonly used (e.g., hydrochlorothiazide, hydrochlorothiazide/triamterene).

  • Carbonic anhydrase inhibitor (e.g., acetazolamide)

• Other agents : systemic steroids, antivirals, benzodiazepines, betahistine

• Chemical ablation with intratympanic gentamicin (injection of gentamicin into the middle ear through the tympanic membrane)

  • First-line for patients with unilateral Meniere disease with recurrent or intractable symptoms unresponsive to pharmacological therapy

  • Usually well-tolerated

  • Greatly reduces vertigo attacks and improves vertigo symptoms

• Intratympanic steroid therapy (injection of methylprednisolone or dexamethasone into the middle ear through the tympanic membrane)

Positive pressure pulse generator devices (e.g., Meniett device) are no longer recommended for Meniere disease.

• Labyrinthectomy (Hearing-sacrificing surgery): destruction and removal of the labyrinth through the mastoid

• Vestibular neurectomy (Hearing preservation surgery): selective transection of the vestibular nerve within the middle cranial fossa via a craniotomy

• Endolymph drainage procedures (e.g., sacculotomy , cochleosacculotomy , endolymph sac decompression ): No longer recommended as they are of doubtful clinical benefit